Endotracheal tube and tracheostomy problems

Critically ill patients can deteriorate suddenly for many reasons, but one of the most feared situations is an airway problem. Whatever the circumstances, a rapid but comprehensive assessment of the airway is always indicated. Intubating a patient with an oral endotracheal tube can be difficult, but the majority of problems occur after intubation. The same is true for patients with a tracheostomy tube in situ. These artificial devices are prone to blockage (obstruction) or displacement. High-risk periods include initial intubation or during tracheostomy, patient movement for procedures or nursing care/rolls, sedation breaks or sedation reduction, and transfers. Continuous monitoring should be in place for all invasively ventilated patients. Waveform capnography is essential. An airway problem where the tube is partially displaced or obstructed can be difficult to diagnose, especially if the problem is visibly not obvious.